1.Photobiomodulation as a novel therapeutic approach in the management of atopic diseases
Medical Lasers 2024;13(4):185-194
Hypersensitivities such as asthma, eczema, and allergic rhinitis, are chronic conditions marked by inflammation and immune system dysfunction. These conditions pose significant health challenges, often leading to an impaired quality of life. Although traditional therapies focus primarily on symptom management, they frequently come with substantial side effects. Photobiomodulation (PBM), a non-invasive treatment involving low-level light therapy, has emerged as a promising alternative. PBM offers a multifaceted approach to addressing the underlying mechanisms of atopic diseases by targeting the key immune pathways, including cytokine production, mast cell stabilization, and T cell modulation. Numerous experimental studies have revealed the therapeutic potential of PBM in various atopic disease models. These findings suggest that PBM may offer a safe and effective adjunct or alternative therapy for individuals suffering from these conditions.Nevertheless, further clinical research is essential to optimize the treatment parameters and fully unlock the therapeutic benefits of PBM. A deeper understanding of PBM’s molecular mechanisms will elucidate its precise mode of action. This can pave the way for the development of targeted therapies that maximize efficacy while minimizing the potential side effects. Ultimately, PBM may revolutionize the management of atopic diseases, offering a more holistic and patient-centered approach to treatment.
2.Development of a Non-Invasive Liver Fibrosis Score Based on Transient Elastography for Risk Stratification in Patients with Type 2 Diabetes
Chi-Ho LEE ; Wai-Kay SETO ; Kelly IEONG ; David T.W. LUI ; Carol H.Y. FONG ; Helen Y. WAN ; Wing-Sun CHOW ; Yu-Cho WOO ; Man-Fung YUEN ; Karen S.L. LAM
Endocrinology and Metabolism 2021;36(1):134-145
Background:
In non-alcoholic fatty liver disease (NAFLD), transient elastography (TE) is an accurate non-invasive method to identify patients at risk of advanced fibrosis (AF). We developed a diabetes-specific, non-invasive liver fibrosis score based on TE to facilitate AF risk stratification, especially for use in diabetes clinics where TE is not readily available.
Methods:
Seven hundred sixty-six adults with type 2 diabetes and NAFLD were recruited and randomly divided into a training set (n=534) for the development of diabetes fibrosis score (DFS), and a testing set (n=232) for internal validation. DFS identified patients with AF on TE, defined as liver stiffness (LS) ≥9.6 kPa, based on a clinical model comprising significant determinants of LS with the lowest Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NFS, FIB-4, and APRI), using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (NPV).
Results:
DFS comprised body mass index, platelet, aspartate aminotransferase, high-density lipoprotein cholesterol, and albuminuria, five routine measurements in standard diabetes care. Derived low and high DFS cut-offs were 0.1 and 0.3, with 90% sensitivity and 90% specificity, respectively. Both cut-offs provided better NPVs of >90% than conventional fibrosis scores. The AUROC of DFS for AF on TE was also higher (P<0.01) than the conventional fibrosis scores, being 0.85 and 0.81 in the training and testing sets, respectively.
Conclusion
Compared to conventional fibrosis scores, DFS, with a high NPV, more accurately identified diabetes patients at-risk of AF, who need further evaluation by hepatologists.
3.Diffuse-Type Histology Is Prognostic for All Siewert Types of Gastroesophageal Adenocarcinoma
Kelly M MAHURON ; Kevin M SULLIVAN ; Matthew C HERNANDEZ ; Yi-Jen CHEN ; Joseph CHAO ; Laleh G MELSTROM ; I. Benjamin PAZ ; Jae Yul KIM ; Rifat MANNAN ; James L. LIN ; Yuman FONG ; Yanghee WOO
Journal of Gastric Cancer 2024;24(3):267-279
Purpose:
The optimal treatment for gastroesophageal junction adenocarcinoma (GEJA) remains controversial. We evaluated the treatment patterns and outcomes of patients with locally advanced GEJA according to the histological type.
Materials and Methods:
We conducted a single-institution retrospective cohort study of patients with locally advanced GEJA who underwent curative-intent surgical resection between 2010 and 2020. Perioperative therapies as well as clinicopathologic, surgical, and survival data were collected. The results of endoscopy and histopathological examinations were assessed for Siewert and Lauren classifications.
Results:
Among the 58 patients included in this study, 44 (76%) were clinical stage III, and all received neoadjuvant therapy (72% chemoradiation, 41% chemotherapy, 14% both chemoradiation and chemotherapy). Tumor locations were evenly distributed by Siewert Classification (33% Siewert-I, 40% Siewert-II, and 28% Siewert-III). Esophagogastrectomy (EG) was performed for 47 (81%) patients and total gastrectomy (TG) for 11 (19%) patients.All TG patients received D2 lymphadenectomy compared to 10 (21%) EG patients.Histopathological examination showed the presence of 64% intestinal-type and 36% diffuse-type histology. The frequencies of diffuse-type histology were similar among Siewert groups (37% Siewert-I, 36% Siewert-II, and 33% Siewert-III). Regardless of Siewert type and compared to intestinal-type, diffuse histology was associated with increased intraabdominal recurrence rates (P=0.03) and decreased overall survival (hazard ratio, 2.33; P=0.02). With a median follow-up of 31.2 months, 29 (50%) patients had a recurrence, and the median overall survival was 50.5 months.
Conclusions
Present in equal proportions among Siewert types of esophageal and gastric cancer, a diffuse-type histology was associated with high intraabdominal recurrence rates and poor survival. Histopathological evaluation should be considered in addition to anatomic location in the determination of multimodal GEJA treatment strategies.